Objective Tessier no. 4 cleft is a very rare craniofacial anomaly, and the primary surgical procedure has not been definitely standardized. The cheek advancement flap, technique, which was first reported by Van der Meulen (1985), has produced cosmetically favorable results. In this report, two cases with Tessier no. 4 cleft, which were treated with the cheek advancement flap technique, are presented. Design and Patients The first case was unilateral and the second was bilateral, and both were accompanied with anophthalmia on the cleft side. At the primary operation, dissection of the nasal soft tissue, medial canthopexy, and reconstruction of the lower eyelid and conjunctival fornix were performed. Cleft lip was repaired according to the rotation-advancement procedure. Results and Conclusions Postoperative appearances were acceptable in both cases, because the resulting scars were made along the esthetic facial units. However, the soft tissue deficiency of the lower eyelid was prominent. Furthermore, in the unilateral case, caudal displacement of the palpebral fissure and cephalic deviation of the nasal ala was recognized.
Usefulness of a “puzzle” flap; more than an advancement flap for surgical reconstruction of nasal ala defects: Review of 10 cases.
